Definition:
Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalentable among cancer patients with and without direct lung involvement.
Dyspnea is believed to be multifactorial, with central, peripheral, and cognitive/emotional components. The respiratory center in the medulla coordinates the activity of the diaphragm, the intercostal muscles, and accessory muscles of respiration. It receives information from central and peripheral chemoreceptors, peripheral mechanoreceptors, and the cerebral cortex. Respiratory effort, hypercapnia, hypoxia, pulmonary stretch, pulmonary irritants, and mismatch between what the brain expects and the feedback it receives are all variables that play a role in dyspnea.
Dyspnea in cancer patients may be due to the direct or indirect effects of tumors, the effects of anticancer therapy, or may be unrelated to the cancer. Possible specific etiologies of dyspnea are listed in Table 1. Despite this extensive list, few studies have systematically categorized the causes of dyspnea in cancer patients.
Patient report of difficulty/uncomfortable breathing - Gold standard of assessment
Normal temperature
Tachycardia
Shallow increased respirations
Increased fatigue
Decreased oxygen saturation (in the upper 80’s)
Arterial blood gas measurements frequently do not correlate with the subjective experience of dyspnea (
For example, patients may be hypoxic but not dyspneic or dyspneic but not hypoxic.)
Absent breath sounds
Anxious
Distressed
Diagnostics:
Chest x-ray shows pleural effusion
arterial blood gas determinations
pulmonary function tests
computed tomography scans
echocardiograms
ventilation-perfusion scans.
Treatment:
After risk-benefit analysis, treatment should be directed at alleviating reversible causes when possible, without neglecting concurrent symptomatic treatment.
Direct tumor symptoms can potentially be treated with resection, chemotherapy, or radiation therapy.
Obstruction can be treated locally with laser therapy, cryotherapy, or stenting.
Malignant pleural effusions can be drained by thoracentesis. Fluid drainage may improve the mechanical ability of the respiratory muscles to relieve dyspnea.
If attempts to control reversible causes is not effective, or if reversible cause is present, symptomatic control of dyspnea may be needed:
Opioids - first-line therapy
Anxiolytics
Oxygen
Cognitive Behavioral therapy
Thoracentesis: A procedure performed to remove the fluid from the space between the lining of the lungs and the wall of the chest
Performed under ultrasound.
A needle is placed through the skin and muscles of the chest wall into the space around the lungs, called the pleural space. Fluid is collected and may be sent to a laboratory for testing.
The procedure:
No special requirements are needed for the patient
The patient needs to be educated on the procedure, and also needs to understand that he/she cannot cough or move during the procedure to prevent injury to the lung
Complications:
Bleeding
Fluid buildup
Infection
Pneumothorax
Pulmonary edema
Respiratory distress
Other teachings for Dyspnea:
Teach relaxation techniques
Teach pursed-lip breathing
Definition:
Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalentable among cancer patients with and without direct lung involvement.
Dyspnea is believed to be multifactorial, with central, peripheral, and cognitive/emotional components. The respiratory center in the medulla coordinates the activity of the diaphragm, the intercostal muscles, and accessory muscles of respiration. It receives information from central and peripheral chemoreceptors, peripheral mechanoreceptors, and the cerebral cortex. Respiratory effort, hypercapnia, hypoxia, pulmonary stretch, pulmonary irritants, and mismatch between what the brain expects and the feedback it receives are all variables that play a role in dyspnea.
Dyspnea in cancer patients may be due to the direct or indirect effects of tumors, the effects of anticancer therapy, or may be unrelated to the cancer. Possible specific etiologies of dyspnea are listed in Table 1. Despite this extensive list, few studies have systematically categorized the causes of dyspnea in cancer patients.
Patient presents with these symptoms:
For example, patients may be hypoxic but not dyspneic or dyspneic but not hypoxic.)
Diagnostics:
Treatment:
After risk-benefit analysis, treatment should be directed at alleviating reversible causes when possible, without neglecting concurrent symptomatic treatment.
If attempts to control reversible causes is not effective, or if reversible cause is present, symptomatic control of dyspnea may be needed:
Thoracentesis: A procedure performed to remove the fluid from the space between the lining of the lungs and the wall of the chest
Performed under ultrasound.
A needle is placed through the skin and muscles of the chest wall into the space around the lungs, called the pleural space. Fluid is collected and may be sent to a laboratory for testing.
The procedure:
No special requirements are needed for the patient
The patient needs to be educated on the procedure, and also needs to understand that he/she cannot cough or move during the procedure to prevent injury to the lung
Complications:
Other teachings for Dyspnea:
Teach relaxation techniques
Teach pursed-lip breathing
References:
http://www.nlm.nih.gov/medlineplus/ency/article/003420.htm
http://imaging.ubmmedica.com/cancernetwork/journals/oncology/images/o0206bt1.gif
http://www.psychiatrictimes.com